Chung Kevin C, Shauver Melissa J, Saddawi-Konefka Daniel, Haase Steven C
Section of Plastic Surgery, Department of Surgery, The University of Michigan Health System, Ann Arbor, MI, USA.
Ann Plast Surg. 2011 Feb;66(2):185-91. doi: 10.1097/SAP.0b013e3181cbfcce.
Although reconstruction is often the primary choice of surgeons after an open tibial fracture, there is no evidence to support the long-term effectiveness of flap reconstruction over below-knee amputation. The aim of this study was to perform a decision analysis to evaluate treatment preferences for type IIIB and IIIC tibial fractures. Reconstructive microsurgeons, physical medicine physicians, and patients with lower extremity trauma completed a Web-based standard gamble utility survey to generate quality-adjusted life years (QALYs). Physicians assigned quite high utility values, and there was a slight preference for reconstruction over amputation, with a gain of only 0.55 QALY. Patients assigned significantly lower utility values and also favored reconstruction over amputation, but with a larger gain of 5.54 QALYs. The disparate utilities assigned by the physicians and the patients highlight the necessity of realistic discussion of outcomes, regardless of the management methods.
尽管在开放性胫骨骨折后重建术通常是外科医生的首要选择，但没有证据支持皮瓣重建术比膝下截肢术具有长期有效性。本研究的目的是进行一项决策分析，以评估对ⅢB型和ⅡC型胫骨骨折的治疗偏好。重建显微外科医生、物理医学医生以及下肢创伤患者完成了一项基于网络的标准博弈效用调查，以生成质量调整生命年（QALY）。医生赋予了相当高的效用值，并且相较于截肢术，对重建术略有偏好，仅获得0.55个QALY的增益。患者赋予的效用值显著更低，并且也倾向于重建术而非截肢术，但增益更大，为5.54个QALY。医生和患者赋予的效用值存在差异，这凸显了无论采用何种治疗方法，都有必要对治疗结果进行切实的讨论。
